2022 Aetna Medicare Eagle Plan (PPO)

Aetna Medicare Eagle Plan (PPO) H3288-050 is a 2022 Medicare Advantage Plan or Part-C by Aetna Medicare available to residents in Texas. This plan does not provide additional prescription drug (Part-D) coverage. The Aetna Medicare Eagle Plan (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,000 out-of-pocket. This can be a extremely nice safety net.

Aetna Medicare Eagle Plan (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Eagle Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Aetna Medicare Medicare Advantage Plan Costs

2021 Aetna Medicare Eagle Plan (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

Yes

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	50-70% coinsurance (Out-of-Network)
Endodontics	20% coinsurance
Extractions	50-70% coinsurance (Out-of-Network)
Extractions	20-50% coinsurance
Non-routine services	20-50% coinsurance
Non-routine services	50-70% coinsurance (Out-of-Network)
Periodontics	20-50% coinsurance
Periodontics	50-70% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	50-70% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	20-50% coinsurance
Restorative services	50-70% coinsurance (Out-of-Network)
Restorative services	20-50% coinsurance

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$0-375 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	0-20% coinsurance
Lab services	$0 copay
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$40 copay

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Doctor Visits

Primary	$0 copay
Primary	30% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$0-40 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40 copay
Foot exams and treatment	30% coinsurance (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$300 copay (Out-of-Network)
$300 copay

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	30% coinsurance (Out-of-Network)
Hearing aids	$0 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	30% coinsurance (Out-of-Network)
Hearing exam	$40 copay

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Inpatient Hospital Coverage

$365 per day for days 1 through 5 $0 per day for days 6 through 90
30% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item (Out-of-Network)
Diabetes supplies	0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$1,871 per stay
Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

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MOOP

$11,300 In and Out-of-network $5,000 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

30% coinsurance per visit (Out-of-Network)
$0-350 copay per visit

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Preventive Care

$0 copay
0-30% coinsurance (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay
Cleaning	30% coinsurance (Out-of-Network)
Dental x-ray(s)	30% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	30% coinsurance (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100
30% per stay (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	30% coinsurance (Out-of-Network)
Other	$40 copay
Routine eye exam	$0 copay
Routine eye exam	30% coinsurance (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Aetna Medicare Eagle Plan (PPO) H3288

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Aetna Medicare Eagle Plan (PPO) Plans Performance

Health Plan Customer Service Rating for Aetna Medicare Eagle Plan (PPO)

Aetna Medicare Eagle Plan (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Aetna Medicare Eagle Plan (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.